Piles and more... dealing with incompetent veins

The day that man took his first steps on his two hind legs is considered a milestone in the evolutionary dominance of mankind. Yet this feat has borne with it one huge burden – the human being is just about the only species to suffer from varicose veins and haemorrhoids, the visible effects of venous insufficiency. Chronic venous disease (CVD) has been described as ‘an abnormally functioning venous system caused by venous valvular incompetence with or without associated venous outflow obstruction, which may affect the superficial venous system, the deep venous system, or both’.1 With the minor inclusion of postthrombotic syndrome, the majority of CVD can be attributed to chronic venous insufficiency (CVI) which is the pathophysiological mechanism for both abnormal leg veins and haemorrhoids.peer-reviewe

The Essential Achille Mizzi, selected, translated, and introduced by Peter Serracino Inglott : a case for performative translation

Delivered on the occasion of the English publication of Achille Mizzi's essential poetry in Maltese, this paper discusses the issue of the translatability of literary works. One of its key arguments concerns the translated poem as an aesthetic orientation neither capriciously free of the original, nor yet restricted to a repeatable meaning. The paper argues that the literary translator, in this case Peter Serracino Inglott, must work at the associative and inferential level, careful not to replicate the identical devices of the original text in a new poetic context where they might be rendered ineffective, but equally careful to project the connotative reach and aesthetic potential inhering in the original work. One consequence of this creative engagement with the original text is the mutual growth of translator and translated work: the translator must submit to the artistically unfolding world of the original text, but also revives its progressive insight with intuitive contributions that maintain its connotative direction. The translator finds his ordinary self previously translated, as it were, by the poetic universe he inhabits, submitting his sensibility to the very archetypal flow and figurative trends that he now extends.peer-reviewe

Beauty and lack thereof in seventeenth- and eighteenth-century travelogues

In the seventeenth and eighteenth centuries, Malta attracted several travellers, eager to discover this small State in the Mediterranean. In spite of the harsh travelling conditions, the traveller did not lose heart and bravely undertook the discovery of the Other, confined to a small island. Strong emotions are felt and judgements are passed, with beauty and ugliness featuring among the most common perceptions that characterize the travelling accounts.peer-reviewe

Jean-Francois de Villages : a cunous, eighteenth-century gentleman

Manuscript 480, conserved at the National Library of Malta, consists of a series of logbooks in French kept by the knight lean-Franrcois de Villages. In the five voyages undertaken, he progresses from a novice-knight to an experienced traveller at the service of the king of France. Particularly during his second and third voyages, Villages gives concise but captivating descriptions of the places of interest visited such as Naples and Florence, together with an artistic appreciation of paintings and artefacts that strike him most. This curious traveller who does not disdain adventure is particularly attracted by the theatre and museums, whose impressions he would like to pass on to posterity. Through his writings, Villages, a French gentleman par excellence, offers the contemporary reader a faithful glimpse of the eighteenth-century culture and mentality.peer-reviewe

Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression : a systematic review and meta-analysis

Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the "gold standard" treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performedpeer-reviewe

A review of the metered dose inhaler technique in asthmatic and COPD patients

To assess the pressurised metered dose inhaler (pMDI) technique using a large volume spacer (LVS) in asthma and Chronic Obstructive Pulmonary Disease (COPD) patients who were admitted in medical wards or attending the outpatient clinic. Asthma or COPD patients were randomly recruited over an eight-month period from the wards and outpatients clinics at Mater Dei Hospital. Only patients using the pMDI were included. Data was collected using a questionnaire filled in by an interviewer who also assessed the inhaler technique using a checklist of 8 steps necessary for appropriate pMDI use. A total of 174 patients, 118 (67.4%) of which are asthmatics while 56 (32%) are COPD patients, were involved. A total score of 8 was achieved by 21 of the asthma patients and 3 of the COPD patients. 154 (88%) of all the patients owned a LVS but only 100 (57.5%) of all the patients used the LVS with pMDI regularly. This study shows that despite the fact that it is a well-known fact that appropriate drug delivery is key to controlling Asthma and COPD, patients still tend to have poor pMDI technique hence the need for patient education with repeated assessment of the technique in follow-up clinics and prior to discharge.peer-reviewe

Novel applications of COX-2 inhibitors, metformin, and statins for the primary chemoprevention of breast cancer

Recent evidence shows that commonly prescribed drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), metformin, and statins, may have beneficial roles in the primary chemoprevention of breast cancer. Therefore, these drugs could potentially be used in addition to the hormonal drugs currently used for this purpose (namely, selective estrogen receptor modulators and aromatase inhibitors) due to their alternative mechanisms of action.peer-reviewe

A case of femoral hernia in a young male

Femoral hernia is an extremely rare condition in infants and children, and is rarely diagnosed before operation. A reducible lump in the groin of a child is by far most commonly that of an inguinal hernia. Conditions which one must bear in mind when confronted with a swelling in the groin in a young child are enlisted. Furthermore, a case report of a child with a one year history of a painful lump in the right inguinal region is described. He underwent two surgeries, wherein the first operation it was thought to be a small reducible right inguinal hernia, and a very small inguinal hernia was excised with no repair being performed. In the second operation the lump was found to be a femoral hernia.peer-reviewe

Computing the Region Areas of Euler Diagrams Drawn with Three Ellipses

Ellipses generate accurate area-proportional Euler diagrams for more data than is possible with circles. However, computing the region areas is difficult as ellipses have various degrees of freedom. Numerical methods could be used, but approximation errors are introduced. Current analytic methods are limited to computing the area of only two overlapping ellipses, but area-proportional Euler diagrams in diverse application areas often have three curves. This paper provides an overview of different methods that could be used to compute the region areas of Euler diagrams drawn with ellipses. We also detail two novel analytic algorithms to instantaneously compute the exact region areas of three general overlapping ellipses. One of the algorithms decomposes the region of interest into ellipse segments, while the other uses integral calculus. Both methods perform equally well with respect to accuracy and time